Myelophthisic Anemia

A hypoproliferative anemia associated with

the infiltration/replacement of
abnormal cells or tissue component
into the Bone marrow

fibrotic,granulomatous or neoplastic
cells

Due to any infiltrative process:

Metastatic carcinoma
Eg. neuroblasstoma in children
carcinoma of the breast, prostate glands, lungs
Hematologic malignancies
Eg. Leukemia, malignant lymphomas,multiple
myeloma
Granulomatous diseases
Eg. Miliary tuberculosis involving the BM and fungal
infections
Lipidoses/ storage disease
-e.g Gauchers Disease, Niemann-pick disease
Diseases like myelofibrosis

Cytokines and growth factors & other

substances
-are released that suppressed hematopoiesis/ destroy stem,
progenitor/ stromal cells

Abnormal cells may replace normal

hematopoietic elements

Disruption of bone marrow architecture

Premature release
of
immature cells from BM occurs

*To maintain blood cell because of unfavorable BM environment

Extramedullary hematopoiesis may develop mostly in

spleen& liver

-resulting to Cytopenia

Pathology
NORMOCYTIC,NORMOCHROMIC

Peripheral blood

increased nonRBCs

Polychromatophilia,basophilic
stippling and reticulocytosis

normocytic RBC w/ teardrop forms

and nucleated RBCs & early myeloid
precursor cells)
Leukoerythroblastosis

WBC count is normal or decreased,

few immature granulocytes present

blood film at 1000X magnification demonstrates a leukoerythroblastic blood picture with the presence of
precursor cells of the myeloid and erythroid lineage. In addition, anisocytosis, poikilocytosis, and
polychromasia can be seen.
*Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University
of Bern, Switzerland.

Anemia of Chronic Kidney

Disease

Anemia commonly occurs in people with chronic kidney

disease (CKD)the

permanent, partial loss of

kidney function.

Most people who have total loss of kidney

function, or kidney failure, have anemia.

The severity of anemia is proportional to the extent of

renal insufficiency.

Failure of renal excretory

function
Accumulation of waste
products in the plasma
Failure of renal production
& release of EPO

 EPO
production
Low levels
iron, vitamin
B12 &folic
acid from
diet

accumulatio
n Uremic
toxins

Anemia
of
CKD
Hemodialysis
Frequent; blood
draws
;gastrointestinal
bleeding

high level of
inflammator
y cytokines
parathyroid
hormone &
spermine in
the plasma

Schematic representation of the mechanisms underlying anemia of CKD. Iron and EPO are
crucial for red blood cell production in the bone marrow.

Babitt J L , and Lin H Y JASN 2012;23:1631-1634

2012 by American Society of Nephrology

serum
creatinine=
hematocrit=
degree of
shortening of
RBC survival
Chemistry

Moderately
Normocytic &
hypercellular;
normochromic,
Burr cells
Erythroid
w/ normal
hyperplasia
indices
some helmet
may be present
Hematology
cells
Bone marrow
fragments may
be present as a
result of uremia

Pathology

cardiovascular
complications

faster
progression
to kidney
failure

suboptimal
quality of
life